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Abstract Background In response to the growing need for effective programmes to promote healthy eating habits among children in real-world settings, we conducted a qualitative study. Our aim was to explore the content-related needs of early childhood education and care (ECEC) staff regarding the core components of an upcoming digital “healthy eating” resource. This resource, designed for real-world implementation through the Nutrition Now project, seeks to enhance children’s nutrition and health within ECEC settings. Methods Twelve individual semi-structured interviews with ECEC staff in a Norwegian municipality were conducted. Subsequently, we conducted two focus group discussions, involving five participants, to encourage reflection on the preliminary findings from the individual interviews. Qualitative thematic analysis was conducted using Nvivo software. Data from the interviews and focus groups were transcribed verbatim and analysed thematically to identify and summarise staff’s subjective experiences and reasoning. Results Six themes were identified for the development of the upcoming digital “healthy eating” resource: (1) A comprehensive recipe bank, and menu suggestions, (2) Tips for easy and quick cooking, simple hygiene and allergy management, (3) Age-appropriate food learning ideas, (4) Strategies for mealtime learning and engagement, (5) Alignment with the national ECEC curriculum, and (6) Parent-friendly access and content. Conclusions This research provides valuable guidance and informs the adaptation of an expert-led digital “healthy eating” intervention to better suit ECEC staff and the ECEC context, consequently enhancing its feasibility and effectiveness. Trial registration This study was not registered in a trial registry as it is not a clinical trial or intervention study but serves as a pilot for the Nutrition Now study, trial identifier ISRCTN10694967 (https//doi.org/10.1186/ISRCTN10694967), registration date 19/06/2022.

Abstract Background Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions. Methods Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC. Results Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access. Conclusion The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization. Trial registration The main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967 . (Registration date: 19-06-2022).

BackgroundFew effective health interventions transition from smaller efficacy or effectiveness studies to real-world implementation at scale, representing a gap between evidence and practice. Recognising this, we have developed Nutrition Now – a tailored digital resource building on four efficacious dietary interventions, aiming to improve nutrition in the important first 1,000 days of life. Nutrition Now targets and guides expectant parents and parents of 0–2 year olds, serves as a reliable source of evidence-based information for midwives and public health nurses at maternal and child healthcare (MCH) centres, and offers pedagogical tools for early childhood education and care (ECEC) staff. The aim of this study is to implement Nutrition Now at scale and evaluate the impact of different sets of multifaceted implementation strategies on implementation outcomes.MethodsA quasi-experimental design with three study arms will be used, providing either low, medium or high implementation support, when rolled out in 50 municipalities in 2 counties in Norway. Nutrition Now will be implemented in MCH and ECEC settings and made available to expectant parents and parents of 0–2 year olds through social media and MCH. The implementation support builds on strategies described in the Expert Recommendations for Implementing Change (ERIC) implementation framework and is informed by dialogues with stakeholders. Impact of the different degree of implementation support will be assessed by examining reach, adoption, fidelity, and sustainability using usage data generated from the Nutrition Now resource, publicly available municipal data and qualitative interviews with MCH and ECEC staff.DiscussionNutrition Now Phase 2 will break new ground by scaling up successively delivered and complementary dietary interventions in the first 1,000 days of life in a real-life context. The project also seeks to identify what level of implementation support is most effective when implementing digital, scalable, evidence-based early-life nutrition interventions in community settings. The project will inform implementation research and provide knowledge about effective implementation strategies to be used in a national scale-up of Nutrition Now.Trial registrationThe study is registered prospectively (submitted 14/06/2022, registration date: 19/06/2022) in the International Standard Randomised Controlled Trial Number registry (ISRCTN): reg. Number: ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967.

Abstract Essential life skills related to food and meals have a potential triple dividend for children and adolescents, that is, short‐term, medium‐term and possible generational effects with regard to public health, sustainability and well‐being of future citizens in local communities. While parents and childhood environments are a basis for learning about food and meals, systematic food education in the setting of primary and lower secondary schools may have a significant role that should be utilized more strongly, reaching and benefitting all pupils from a life course perspective. Through this article, we explore the current state of the art of the mandatory school subject Food and Health (FH) from the Nordic perspective. Our leading questions are: (1) What potential is currently utilized and which future potential does FH education have in primary and secondary schools in terms of food education for essential life skills and competencies, and (2) How can this untapped potential be better harnessed with a goal of facilitating better learning in FH? Drawing on data from Norway as a case study, supported by Swedish and Finnish data, we discuss the status, challenges and potential reformation of food education, focusing on FH. This includes perspectives on the prioritization of the FH subject and the organization of more systematic food education in schools, which might improve FH's status and significance. Combining theory–practice, creating room for discussion and focusing less on cooking‐related activities may better facilitate learning in FH. Without proper FH, food education might be nonsystematic, thereby generating unequal outcomes for children and adolescents.

Abstract Background Understanding the associations between health behaviors and which subgroups are at risk of developing health risk behaviors is vital knowledge to develop effective public health interventions to reduce the high prevalence of non-communicable diseases (NCDs). The objective of the study was to assess the association between physical activity, diet, tobacco use, and alcohol consumption and sociodemographic determinants (sex and education), and to examine clustering patterns of these health behaviors. Method Data was collected from an online self-reported questionnaire from the Norwegian public health survey conducted in 2019. The study sample consisted of 28,047 adults (≥ 18 years old) from Agder county in Southern Norway. Chi-square tests and logistic regression analysis were used to determine the association between sex and education according to physical activity, diet, tobacco use and alcohol consumption. Linear regression was used to examine the association between educational level and number of health risk behaviors, and cluster analysis were performed to determine cluster patterns. Results Females were more likely than men to meet the national public health recommendations for diet (p

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0–2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice.Clinical Trial Registrationhttps://www.isrctn.com/, identified ISRCTN10694967.

ObjectiveUniversities have a role in educating and empowering students to become healthy and literate citizens of the 21st century society. The aim of this study was to explore university students' perceptions regarding the relevance and utility of a planned dietary life skills course.DesignQualitative design including focus group discussions.SettingA Norwegian university with participating undergraduate students from seven different disciplines.MethodData collection included 13 semi-structured focus group discussions involving 57 university students (35 women and 22 men aged 18-38 years). The focus group discussions were recorded and transcribed verbatim. To ensure in-depth knowledge of the research participants' thoughts and reflections, thematic analysis strategy was undertaken by a team of researchers.ResultsWhen presented to the idea of a dietary life skills course as a university course, the students were mostly positive regarding its relevance and utility, however both motivators and barriers for attending were put forward. Some mentioned potential academic course benefits, such as enhanced CV, and a few mentioned potential societal benefits such as a healthy population and sustainable food consumption. Several motivators for attending the course were launched, such as increased knowledge and cooking skills, having dinner and expanded network. The students wanted to learn about food, nutrients and health, and how to cook simple, affordable, healthy and sustainable meals. Potential barriers for attending were mostly related to practicalities, such as potential lack of alignment with ordinary study programme or too demanding lectures.ConclusionMost students acknowledged the value of a dietary life skills course and thought that such a course could benefit their personal life. This encourages the offering of such courses at university level, tailored to consider both motivators and barriers for attending.